Two out of three hospital eye units reliant on locums to fill senior doctor posts

Author: Caroline White
Two out of three hospital eye units reliant on locums to fill senior doctor posts
Two out of three hospital eye units are reliant on locums to fill consultant posts as recruitment to senior roles becomes increasingly difficult, finds the latest workforce census* carried out by the Royal College of Ophthalmologists (RCOphth).

The 2018 census points to a severe shortage of eye doctors and gaps in workforce planning amid a predicted 40% increase in demand over the next 20 years.

It shows that two-thirds (67%) of hospital eye units are using locum doctors to fill consultant posts─ an increase of 52% since 2016─ and that this is against a background of around a quarter of the current workforce nearing retirement.

It estimates that over the next two years an extra 230 consultant and 204 Staff and Associate Specialist (SAS) posts will be needed to cope with demand.

Most (85%) units have put waiting list initiatives in place in a bid to manage demand, the figures show.

The census shows that not only are services dealing with a severe shortage of ophthalmologists but also insufficient clinic space to cope with the continuing increase in demand, caused by an ageing population and welcome new treatments for previously untreatable conditions.

Improvements in efficiency and extended roles for non-medical and community staff can’t compensate for the growth in the numbers of patients affected by long-term eye disease, says the College.

“There is a widespread misconception that ophthalmology is a small specialty delivering mainly elective minor procedures and the risk of harm is low. This is not the case,” explained Jane Harcourt, chair of the RCOphth Workforce Committee.

“Ophthalmology is a major service, dealing with nine million outpatient appointments every year and delivering 6% of all surgery in the NHS. The census highlights the continuing serious shortage of ophthalmologists and a widespread use of locums.”

Ophthalmology is now the busiest outpatient specialty, with a predicted increase in demand of 30-40% over the next 20 years, says the College.

The current training places available each year will fall far short of the 230 extra consultant posts required over the next two years.

What’s more, the 2018 census figures show that recruitment to vacant posts is becoming increasingly difficult. Heavy reliance on the extensive use of locum doctors to fill consultant posts can present safety risks to patients, as locums often work in unfamiliar environments and, in some cases, may be less experienced or qualified than would be expected of a permanent consultant, warns the College.

Hospital Eye units are undertaking waiting list initiatives to attempt to manage demand. But in 2017, the RCOphth and British Ophthalmological Surveillance Unit (BOSU), found patients with permanent and severe visual loss due to health service-initiated delays.

Loss of sight increases the risk of other health related issues including falls, depression and dementia, which has a direct impact on health, social care and society, says the College. The overall cost of sight loss is estimated to be £28 billion in the UK.

“Our patients deserve better. Policy makers, NHS leaders and commissioners must recognise and understand the significance of eye conditions and sight loss and give ophthalmology the priority it deserves – before hundreds more patients suffer permanent and avoidable loss of sight,” urges Melanie Hingorani, chair of the RCOphth Professional Standards Committee.

The NHS Long-Term Plan is welcome, says the College, but it doesn’t address the lack of capacity in the workforce which will be required to achieve its ambitions.

The 2018 workforce census highlights the importance of securing a long-term workforce strategy that invests in a sustainable ophthalmology service to meet the growing burden of demand and protect patients from preventable sight loss, it insists.

*Workforce Census 2018. The Royal College of Ophthalmologist, 31 January 2019.